Dr. Donohue: You must put infection in perspective

By Paul G. Donohue, M.D.
DEAR DR. DONOHUE: I have herpes. I am a 28-year-old woman who never previously had a venereal disease. I am shocked to have one now. I have always been careful about choosing my male partners. I can’t believe this has happened to me. Will this affect my chances of having children? What do I do about having sexual relations? – M.N.
ANSWER: You have to put herpes infection in perspective. Many people are infected. It’s estimated that 50 million Americans have the virus. All of them are free to marry and have children. As for sexual relations, be honest with your partners about having been infected. You should not have relations when you have a recurrent outbreak. Recurrences lessen in frequency with the passage of time. It still is possible to transmit the virus without a visible outbreak, but condom use then lessens the probability of passing the virus to others.
The herpes virus comes in two varieties: herpes simplex virus type 1, HSV-1; and herpes simplex virus type 2, HSV-2. HSV-1 is responsible for cold sores (fever blisters). HSV-2 is the cause of genital infections. However, either virus can lead to genital infections (and cold sores). HSV-1 is becoming a more frequent cause of genital infections.
Skin-to-skin contact is the method of transmission. A first outbreak of genital herpes may cause fever, headache, muscle pain, pain on urination and enlargement of groin lymph nodes.
In men, an outbreak of small blisters appears on the penis. In women, the same happens in the vagina and on the external genitals. The blisters turn into sores. The sores heal in one to two weeks. Some infected people never have any visible manifestations of infection, but they are able to transmit the virus. About one-third of people never experience a recurrence. Another third have less than three outbreaks a year. The final third have more than three yearly outbreaks. People can spread the virus even when there are no obvious signs of infection.
Acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex) shorten an outbreak. If recurrences are frequent, these medicines can be used on a daily basis to suppress them.
The booklet on herpes clarifies its mysteries. Readers can order a copy by writing: Dr. Donohue, No. 1202W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

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DEAR DR. DONOHUE: I am celebrating my 75th birthday in two months. Up to now, I have had mammograms every year, sometimes every two years. Can I stop? – W.B.
ANSWER: The benefits of mammograms for women between the ages of 50 and 69 are not disputed. When to start them and when to stop them are matters that stir up debates. Many would like to see a directive for beginning mammograms at age 40.
A sensible approach to your question about stopping is this: a woman older than 70 should continue to have mammograms if that woman has 10 more years of expected life. Your doctor can give you an idea of what your life expectancy is.